Meningitis Flashcards

1
Q

What is meningitis

A

Inflammation of the protective membranes (Meninges) covering the brain and spinal cord.

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2
Q

Causes of meningitis

A

• Viruses
• Bacteria
• Certain Drugs
(crossing the blood brain barrier

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3
Q

Subpial Encephalopathy

A
  • Ischaemic cell changes
  • Neuronal loss
  • Seizures in bacterial meningitis (Bad prognosis)
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4
Q

Signs of subpial encephalopathy

A

Subpial Encephalopathy
• Ischaemic cell changes

  • BehavioUral change
  • Altered level of consciousness
  • Convulsions
  • Paralysis
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5
Q

Vasculitis causes

A

• Phlebetic Process
• Vasculitic signs become evident in the 2nd – 3rd
week post infection

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6
Q

Signs of vasculitis

A
  • Hemiplegia
  • Cortical blindness
  • Decorticate/ Decerebrate rigidity
  • Coma
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7
Q

Signs and symptoms of meningitis

A
• Rigidity
• Sudden high fever
• Altered mental status
• Increased irritability
• Neck stiffness and pain
• Neck retraction and back extension
• High Fever (cold hands and feet)
• Lethargic
• Increased sensitivity to light
Seizures
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8
Q

Indicators of increased ICP

A
Headache
• Vomiting
• Neck Stiffness
• Bulging fontanelle
• Sutural Separation: “Cracked Pot” Note called Macewen’s sign 
• Papilloedema – optic disc swelling
• Neural tension
Kernigs sign
Brudinzki
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9
Q

Meningitis diagnosis

A
Blood tests
• CRP (c-reactive protein)
• Blood Culture • Blood count
Lumbar Puncture 
• WBC
• RBC
• Bacteria / virus
• Decreased sugar
 • Frank pus
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10
Q

Casualty management

A
  • BP; HR; O2 Saturation; GCS
  • Lumbar puncture to test for infection • Drip to maintain hydration levels
  • Identify source of infection
  • CXR
  • UrineTest
  • CT(Suspecttrauma,tumour,abscess)
  • Control seizures
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11
Q

Ward Mx

A
ICU for observation (if necessary)
• Ventilate/ oxygenate (if necessary)
• Treat source of infection (antibiotics)
• Steroids to reduce inflammation of the meninges 
• Maintain hydration
• Control fever
• MDT approach
• Control seizures
• Control ICP
• Mannitol (diuretic)
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12
Q

Physiotherapy Rx

A
Chest Physio
• Source of Infection
• Compromise recovery
• Aspiration
• Precautions and Contra-Indications
  • Rehabilitation
  • Prevent
  • Contractures
  • Bed Sores
  • Strengthen muscles
  • Improve function-Highest functional level
  • Education
  • MDT approach NB
  • Adequate follow up
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13
Q

Complications

A
  • Rash
  • Cerebral Oedema
  • Subdural Effusions
  • Convulsions
  • Hydrocephalus
  • Inappropriate ADH secretion
  • Cerebral infarction
  • Deafness
  • Subdural empyema and brain abscess
  • Impaired motor and cognitive function
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14
Q

Prognosis

A
• Bacterial meningitis if untreated is almost always fatal
• Viral meningitis is hardly ever fatal
Severity
• Age dependent
• Underlying cause
• Time taken to receive treatment
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15
Q

TB meningitis

A

Infection
• Reactivation of latent TB
• Complication of existing TB
• Reaches the meninges through the BBB
• The bacteria forms metastatic caseous lesion
• Rich’s Focus
Untreated TBM leads to death in 6 – 8 weeks

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16
Q

Tb meningitis

A
  • Meningeal infection caused by rupture of a caseous focus (Rich’s focus)
  • Subcortical region
  • Subarachnoid space
  • Triggers inflammatory response • Base of the brain = tubercles
  • Gravity dependant
  • Thick exudate covers the cranial nerves, blood vessels and choroid plexus
17
Q

Stage 1 TB meningitis

A

– Signs of meningeal irritation
– No hydrocephalus
– No neurological signs
– Altered consciousness

18
Q

Stage 2 TBM

A

– Confusion
– Focal neuro signs
• Squints
• Hemi

19
Q

Stage 3 TBM

A
  • Stupor
  • Delirium
  • Neurological signs
  • Hemi
  • Para
20
Q

Symptom of TBM

A
Papilloedema
• Cranial Nerve VI
• Sudden onset of neurological deficits • Hemi
• Para
• Aphasia
• Cerebellar dysfunction 
• Tremor
21
Q

Diagnosis of TBM

A
  • Lumbar Puncture
  • CSF
  • ↑ Cells
  • ↑ Protein • ↓ Sugar
  • ↓ Chloride
  • Careful history
  • Skin test (Mantoux test)
22
Q

Treatment of TBM

A
  • Prevention
  • TB medication
  • Symptomatic
  • Physiotherapy
  • Occupational Therapy